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A study of the reliability and validity of the Six-Spot Step Test Cognitive in ambulatory people with diabetic
Alexander Kjær Laugesen1, Esben Køhler1, Christian Selmer Buhl2
1Research Centre for Care and Rehabilitation, Research Program for Balance and Falls, VIA University College, Aarhus, Denmark.
Abstract:
ObjectivesCognitive decline and impaired balance are well-documented in people with diabetic peripheral neuropathy; however, no ambulation assessments currently address the cognitive dual-task demands specific to this population. The Six-Spot Step Test Cognitive is a brief, functional mobility test designed to equally emphasize cognitive and motor components. This study evaluated its construct validity and test-retest reliability in people with diabetic peripheral neuropathy.DesignCross-sectional study.SettingOutpatient clinics.ParticipantsFifty-five people with diabetic peripheral neuropathy.Main measuresThe Six-Spot Step Test Cognitive was completed twice within the same day and again three to seven days later. Additionally, the cognitive Timed "Up and Go" test and the Mini-BESTest were administered on the last day. Reliability and validity were estimated using Bland-Altman statistics, the minimal difference, Intraclass Correlation Coefficient, and Spearman's rank correlation coefficient.ResultsThe Six-Spot Step Test Cognitive was found reliable (Intraclass Correlation Coefficient: 0.88-0.92; minimal difference: 27.2%-31.4%) and showed moderate construct validity to the cognitive Timed "Up and Go" test (Spearman's rank correlation coefficient = 0.55, p < .001). Weak correlations with the Mini-BESTest (Spearman's rank correlation coefficient = -0.26, p < .06) indicated low construct validity. Significantly higher dual-task costs were observed when performing the Six-Spot Step Test Cognitive (58.7%) compared to the cognitive Timed "Up and Go" test (29.6%).ConclusionsIn people with diabetic peripheral neuropathy, the Six-Spot Step Test Cognitive demonstrated promising construct validity and acceptable to excellent reliability, making it a valid measure of functional mobility, including cognitive dual-tasking. Additionally, a higher dual-task cost indicated actual cognitive-motor interference while performing the test.
